Radiographic diagnosis of incipient proximal caries: an ex-vivo study

Abstract

The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-microm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6% and 83.3% for clinical examination and 29.7% and 95.8% for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.

Comparison of different caries detectors for approximal caries detection

“…Since the proximal carious lesions started being visualized radiographically at the level of half the inner enamel, radiography is not the most indicated method to detect incipient carious lesions confined to the enamel, being more effective for lesions that have already reached the dentinoenamel junction 23 . Therefore, bitewing radiography is useful for the diagnosis of dentin decay on both occlusal and proximal areas.…”

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions

“…At this stage, the lesion is macroscopically non-cavitated and can be seen when the tooth surface is wet (but must still be visible when dry) [29]. The visual clinical examination has been considered the best method for diagnosis of proximal caries [21] and was implemented with the current experiments. From a previous paper, however, it is well known that cavitations can be easily overlooked during observation with the naked eye, even under perfect laboratory conditions [19].…”

“…Consequently, lesions with higher mineral loss (and increased radiolucency) correspond well to advanced clinical lesions [21] and usually show increasingly roughened surfaces. With regard to differences between premolars and molars, it should be emphasized that an initial proximal lesion in molar tooth surfaces is prone to be underestimated about double that in premolars [22]; in other words, lesions of the same histologic dimension are more radiolucent with premolars, while lesions of the same radiologic breadth (e.g., E2 or D1) should reveal an increased mineral loss, a higher pore volume, and a more roughened surface with molars.…”

Photoacoustic imaging of occlusal incipient caries in the visible and near-infrared range

“…However, visual inspection is a subjective method in which the professional's experience directly influences the diagnosis, and a certain level of demineralization is necessary for tissue to be visible on a radiograph. 4 5 Due to these limitations, the last few years have seen an increased interest in the development of new methods of caries diagnosis with highly accurate and non-invasive methods, such as transillumination, fluorescence-based imaging, optical coherence tomography (OCT), and photoacoustic (PA) imaging. 6 7 8 9 10 11 12 13 …”